Abstract
<p>Background: Postpartum depression (PPD) and postpartum anxiety (PPA) affect approximately 10–20% of mothers worldwide and frequently co-occur, yet growing evidence suggests they may be associated with distinct neural mechanisms, require differential treatment strategies, and have unique impacts on child outcomes. The present review synthesizes findings concerning the neural changes associated with PPD and PPA, how those changes relate to parenting and child outcomes, and the neural mechanisms by which treatment approaches improve outcomes in postpartum mothers. Main Text: Normative neurobiological changes during pregnancy involve hormonal fluctuations in estrogen, progesterone, oxytocin, and prolactin that contribute to gray matter volume reductions in social cognition regions, alongside white matter and functional changes, collectively priming the maternal brain for caregiving. These structural changes partially recover during the postpartum period, with the magnitude of recovery associated with greater parental self-efficacy. Mothers with PPD and PPA show partially distinct neural profiles relative to healthy postpartum mothers. PPD is associated with HPA hyperactivation and elevated cortisol, reduced executive control network connectivity, and mixed salience network disruptions, consistent with its behavioral profile of anhedonia and reduced emotional availability. Research on PPA neurobiology is more limited; however, existing evidence suggests heightened salience network activity, stronger prefrontal-striatal connectivity, and a distinct HPA profile of lower cortisol output, consistent with the heightened negative emotions and anxious caregiving associated with PPA. Regarding treatment, evidence from broader mood and anxiety disorder populations suggests CBT and SSRIs influence neural circuits involved in affective regulation and executive control, while GABA modulators target GABAergic pathways at the receptor level, though direct neuroimaging studies of treatment response in postpartum populations remain absent. Conclusion: PPD and PPA have partially distinct neurobiological underpinnings, potentially requiring unique treatment approaches. Future research is needed to better understand how these neurobiological changes relate longitudinally to maternal mental health and child outcomes and how established treatments impact brain structure and function in postpartum mothers. Advancing this line of research will be important for informing specific targets for prevention and intervention programs.</p>